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Risk factors for postoperative infection after non-elective femur fracture fixation in pediatric patients
Levi M Travis1, Natalie K Blanc1, Victoria Hinchberger1
1University of Miami Miller School of Medicine, Department of Orthopaedics, 1400 NW 10th Ave, Miami, Fl 33131, United States.
Insights
Identifying risk factors for pediatric femur fracture fixation infection is crucial. External fixation and blood transfusions increase infection risk, impacting outcomes and healthcare costs.
Area of Science:
- Orthopedic Surgery
- Pediatric Trauma
- Infectious Disease Epidemiology
Background:
- Pediatric femoral shaft fractures are common, necessitating surgical fixation.
- Postoperative infections are a significant complication, but specific risk factors in children are not well understood.
Purpose of the Study:
- To identify independent predictors of postoperative infection following pediatric femur fracture fixation.
- To analyze the impact of infection on length of stay and hospital charges.
Main Methods:
- Analysis of 14,037 pediatric patients from the 2019 and 2022 Kids' Inpatient Database (KID).
- Multivariable logistic regression to determine predictors of soft tissue, device-related, and overall infection.
- Secondary outcome assessment of length of stay (LOS) and hospital charges.
Main Results:
- Overall infection rate was 0.6%; soft tissue infection (0.4%) and device-related infection (0.3%).
- Nondisplaced fractures significantly increased device infection odds (OR 35.2), while open fractures were protective (OR 0.12).
- External fixation (OR 4.65) posed higher infection risk than intramedullary nailing; blood transfusion predicted infection across categories (OR 2.6-3.5).
- Soft tissue infection substantially prolonged LOS (20.5 vs 4.2 days) and increased hospital charges ($421,798 vs $111,845).
Conclusions:
- Novel, actionable risk factors for pediatric femur fracture fixation infection were identified.
- High-risk groups include patients receiving external fixation or blood transfusions.
- Findings support targeted prevention, perioperative optimization, and surveillance strategies to improve surgical decision-making and resource utilization.
Background:
Pediatric femoral shaft fractures are common and often require surgical fixation. Postoperative infections remain a serious complication, yet risk factors specific to this population are not well defined.
Methods:
We analyzed 14,037 pediatric patients undergoing non-elective femur fracture fixation in the 2019 and 2022 Kids' Inpatient Database (KID). Multivariable logistic regression identified independent predictors of postoperative soft tissue, device-related, and overall infection. Secondary outcomes included length of stay (LOS) and hospital charges.
Results:
Infections occurred in 0.6% of patients (0.4% soft tissue, 0.3% device-related). Nondisplaced fractures had sharply increased odds of device infection (OR 35.2, 95% CI 4.7-189.7, p < 0.001), while open fractures were protective (OR 0.12, 95% CI 0.01-0.58, p = 0.039). External fixation conferred the highest infection risk versus intramedullary nailing (OR 4.65, 95% CI 2.25-9.13, p < 0.001). Blood transfusion consistently predicted infection across categories (OR 2.6-3.5, all p < 0.01). Soft tissue infection prolonged LOS (20.5 vs 4.2 days, p < 0.001) and raised hospital charges ($421,798 vs $111,845, p < 0.001).
Conclusion:
This study identifies novel and actionable risk factors for postoperative infection following pediatric femur fracture fixation. Recognition of high-risk groups, including those receiving external fixation or transfusion, may guide targeted prevention, perioperative optimization, and surveillance strategies. These findings have important implications for surgical decision-making and healthcare resource utilization in pediatric orthopedic trauma.
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